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Health impacts of the living conditions of people residing in informal settlements in Freetown: Report on the Future Health Systems (FHS) research in Freetown

Future Health Systems

The rapid pace of urbanisation in most countries in Africa makes urban environments a major determinant of population health. In Freetown, urban growth is associated with the proliferation of informal settlements/slums owing largely to the prevalent poverty, overcrowded and filthy living conditions. Therefore, health outcomes are generally worse with intermittent disease outbreaks which can sometimes spread beyond a single neighbourhood to overwhelm the entire city. But, while a number of studies have documented evidences on the urban health situation in Freetown, such studies have not sufficiently explained the specific and community-wide health risks that people in each informal settlement are faced with. The study describes the living conditions in informal settlements, and explore how these relate to the health of people living there, as told and understood by the residents themselves and as reported in routine statistics.

Three key lessons from the study were that first, the right to basic services remain unrealised for the majority of poor and vulnerable people since tenure insecurity and the lack of appropriate space inhibits the expansion of service infrastructure. This reality underlies the appalling living conditions in informal settlements and hence, the health situation. Second, services provided (e.g. drugs) and the accompanying health infrastructure (e.g. delivery beds) do not meet the current (and maybe long term) needs and affordability of poor and vulnerable groups. Overcoming drug scarcities and water and electricity outages remain a big challenge to most PHCs. Third, the location of informal settlements and the nature of the terrain are critical for the health risks faced in different communities including their access to health care and the provision of services such as water.

Four main recommendations were that:

  • slum upgrading programmes should be promoted as a deliberate effort to improve the locations as well as make them better serviced
  • public health planning should give special consideration to the needs of poor and vulnerable informal settlement dwellers who are constantly faced with health problems associated with their poor living conditions
  • efforts be intensified to increase access especially to people living in hard-to-reach areas including areas located far away from the nearest PHC
  • the government to recruit more CHWs and to strengthen their relations with CHMCs in ways that will improve community awareness as well as allow them to work mutually in dealing with the local health problems.